Voivods' Plans for a National Emergency System

• Abstract
• Characteristics of this policy
• Purpose and process analysis
• Expected outcome
• References

Featured in half-yearly report: Health Policy Developments Issue 6

Abstract

According to article 21, Law on a National Emergency System from 8 September 2006, in 2007 the voivods' plan for the creation of a national emergency system was tansformed into an MoH proposal of executive law for the first time. The executive law, which regulates the functioning and the criteria for cost calculation of emergency team activities, was implemented after long consultations with many stakeholders involved into the legislation process.

Neue Entwicklungen

In the described executive regulation, the MoH defines the rules for algorithm setting (determinant indicators) such as:

• characteristics of the region: population number, population density, configuration of the terrain, education structure, communication network etc.
• number of events that cause a state of sudden health threat on the area of the particular voivodship
• resources available in the region (the number of medical rescue teams, the maximum time for reaching the accident place, the number and localization of hospitals, especially those equiped with Hospital Emergency Units (SORs)
• number and equipment of Centers for Emergency Calling (CPR) - receiving the alarm calls and coordinating the activities
• the organisation of the system for notification in crisis
• the number of available units of fire brigades, police units, airplanes in the region
• planned new units of Centers for Emergency Calling, Hospital Emergency Units (SORs) in the region for the next year.

To the executive law, a plan of national emergency system actions with special statistical charts is attached. These charts should be used in all 16 voivodships to present the data in tabular form. In the charts are collected information like e.g. the characteristics of the communication network in the voivodship, the urban structure with the most dangerous places, the number of rescue team interventions, the number and the distribution of hospitals with special emergency units in the voivod area.

The criteria for calculating the cost of medical rescue team activities are applicable to both: the indirect costs (administrative and economic costs and the amortization rate) and the direct costs (personal and exploitation costs). In Poland almost no emergency service does provide other activities so all the costs of supporting team are calculated.

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral
current    previous

The policy introduced by the described executive law was one of the most necessary issues. All groups engaged in the problem agreed as to the fundamental priority question. Disagreement concerns some particular issues: financing (cost calculation), structure, organization and control.

The emergency system law and the described policy constitute systemic and general resolutions, including the overall and general objective, which is to ensure an effective and efficient emergency system in the frame of the healthcare system.

The idea of the plans to create a national emergency system at the regional level aimed at the better integration of the system and it is not new and quite specific for many other healthcare systems.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Initiators of idea/main actors

• Regierung: Governmental administration is responsible for the overall process of realization of the executive law, starting with the agreements between MoH, MoF, Ministry of Administration and Internal Affairs. Voivods are the main stakeholder of policy implementation.

• Leistungserbringer: The diversity of provider supervisory bodies (local administration authority as the owner of hospitals, the voivod (governmental agenda) ? the owner of critical reaction teams) can complicate the organization and procedures of coordination between them.

• Kostenträger: Plans should be consulted with directors of the regional units of the National Health Fund.

• Patienten, Verbraucher: The implementation of the described policy will influence the safety of patients in the region - they will benefit from the proper organization of the regional emergency system.

• Bürgergesellschaft: Trade unions are interested in proper criteria for both: the medical rescue teams and technical operation service functioning cost calculation.

• Andere: Plans should be consulted with the chief of the voivod's military staff, army commandants for medical districts, voivod fire brigade chiefs and police chief.

Stakeholder positions

The proper legislation and implementation of the policy requires intergovernmental agreement made especially between the Ministry of Health and the Ministry of Administration and Internal Affairs (MoAaIA). On the 26th of April 2007 the Law on Crisis Management was implemented. The law needs executive regulation which should be prepared by MoAaIA. Both executive laws (prepared by both ministries) concern similar aspects and should be agreed to achieve unification of the planned procedure.

The described regulation concerns the aspect of cost calculation of rescue team activities financed from the budget and it also requires MoF approval.

The influence of all governmental resorts engaged in policy legislation and implementation is very strong, and so is their position. The most important stakeholders that influence the policy implementation to a high extent are voivods - local governmental authorities that have particular and specified competences (and responsibilities) in the sphere of monitoring and control of the regional emergency system. The NHF supports the executive law in general and its influence is strong due to the necessity to consult the plan with the directors of the regional units of the National Health Fund. Plans should also be consulted with the chief of voivod military staff , army commandants of medical districts, voivod fire brigade chiefs, police chief  and patients. Patients support the project (idea) because they expect better organized plans of regional emergency system.

Actors and positions

Regierung
MoH	sehr unterstützend		stark dagegen
MoF	sehr unterstützend		stark dagegen
MoAaIA	sehr unterstützend		stark dagegen
Voivod - regional governmental administration	sehr unterstützend		stark dagegen
Leistungserbringer
Hospital Emergency Units (SOR)	sehr unterstützend		stark dagegen
Medical rescue teams	sehr unterstützend		stark dagegen
Kostenträger
NHF	sehr unterstützend		stark dagegen
Local units of NHF	sehr unterstützend		stark dagegen
Patienten, Verbraucher
Patients	sehr unterstützend		stark dagegen
Bürgergesellschaft
Trade Union of Medical Rescue and Technical Operation Service	sehr unterstützend		stark dagegen
Andere
Police	sehr unterstützend		stark dagegen
Fire brigade	sehr unterstützend		stark dagegen
Army	sehr unterstützend		stark dagegen
current    previous

Influences in policy making and legislation

The original proposal of the executive law has been modified in the process of law legislation under the influence and intervention of voivods and and the Ministry of Administration and Internal Affairs. In the final version of the MoH regulation the number of potential risks for health and life have been limited to the most important statistical information like e.g: demographic data, communication network, the resource availability in the region (ie. the number of medical rescue teams, the maximum time for reaching the accident place, the number and localization of hospitals, especially those with hospitals emergency units (SORs). The recommendation for the cooperation between MoH and MoAaIA has been made: the need for the unification of common activities on the voivodeship level.

During the consultation process of the executive law project, MoAaIA suggested to specify the concept of an operation district more precisely. The concept accepted in the final version of the regulation describes an operation district as a "time district"  (the maximum time for reaching the accident place). The "time district" is therefore understood as not strictly connected to the territorial division.  

The voivods and trade unions suggested to present proper criteria for calculating the costs of medical rescue team activities in the regualtion, both direct cost (personal and exploitation costs) and indirect costs (administrative, economic and rate of amortization). After the intervention of the Trade Union of Medical Rescue and Technical Operation Service, the amortization applies also to all units, including those financed from the central budget (previously excluded).

Legislative outcome

Hold

Actors and influence

Regierung
MoH	sehr groß		kein
MoF	sehr groß		kein
MoAaIA	sehr groß		kein
Voivod - regional governmental administration	sehr groß		kein
Leistungserbringer
Hospital Emergency Units (SOR)	sehr groß		kein
Medical rescue teams	sehr groß		kein
Kostenträger
NHF	sehr groß		kein
Local units of NHF	sehr groß		kein
Patienten, Verbraucher
Patients	sehr groß		kein
Bürgergesellschaft
Trade Union of Medical Rescue and Technical Operation Service	sehr groß		kein
Andere
Police	sehr groß		kein
Fire brigade	sehr groß		kein
Army	sehr groß		kein
current    previous

Positions and Influences at a glance

Adoption and implementation

First of all, the voivods are involved in the policy implementation process. It is hard to say how successful the implementation of the policy has been by now because the first plans for national emergency system activity on the regional level are being created just at the moment, for the years 2008- 2011. The main obstacle to the policy implementation process could be the multitude of provider supervisory bodies (local administration authority as the owner of hospitals, the voivod (governmental agenda) - as the owner of critical reaction teams.

Monitoring and evaluation

The described policy has not foreseen a monitoring and evaluation procedure, it has the form of an executive law to the Law on National Emergency System.

As it was very precisely indicated in the last reports on the emergency system in Poland, the process of monitoring and control on the level of voivodships includes three main spheres:

• cooperation with the system units - police and fire brigades
• the health care units on the voivodship level (adequately to the roles and procedures defined in the law on health care units provisions)
• the education units - that is the rescue courses (checking the standards defined in the Law on National Emergency System)

The evaluation and monitoring tasks are also realized by the physician coordinators of medical rescue who are employed by the Voivodship Centre for Crisis Management.

The measuring indicators have been determined independently from the introduced law (they were applied for quite a long period of time): they concern the question of reducing the time between an accident and hospital admission to 8 minutes within the cities and to 15 minutes outside the cities, for 75% of emergency calls.

Expected outcome

From the expert point of view the policy should achieve the main objectives, but there are also the above defined obstacles (especially concerning organizational and structural issues, ie. the multitude of provider supervisory bodies) that could disturb the process of goal achievement.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch
current    previous

The impact on quality of healthcare services is obviously very important: reducing the time span between an accident and hospital admission should significantly influence the service quality.

For the level of equity the policy will not bring any substantial change, but due to the improvement in the functioning of medical dispatchers (rules of information, data collection and of decision making), equity may also be improved.

The impact on cost-efficiency is potentially large: specified information, better effectiveness of rescue team's activities should positively influence the cost-efficiency relation.

References

Sources of Information

• The Law from 8th of September 2006 on National Emergency System, O.J. no 191, clause 1410. 
• The Law from 25th of July 2001 on National Emergency System, O.J. no 113, clause 1207 with amendments.
• The Executive Law of MoH from 20th of June 2008 on voivod plan of National Emergency System activity and criteria of emergency teams activities cost calculation
• The opinions to the Executive Law project made by all 16 voivodes; see: www.mz.gov.pl
• J. Brysiewicz, The opinion to of Minisrty of Administration and Internal Affairs to the Executive Law project on voivod plan of National Emergency System activity and criteria of emergency teams activities cost calculation, June 6, 2007.

Reform formerly reported in

The Emergency System Process Stages: Gesetzgebung

?Law on medical emergency service project? Process Stages: Umsetzung

Author/s and/or contributors to this survey

Iwona Kowalska

Dr Iwona Kowalska, lecturer in the Institute of Public Health, Medical Collage, Jagiellonian University. She graduated in Political Science at the Faculty of Law and Administration, Jagiellonian  University.  The main areas of her research are: health and social policy, European health policy and health care systems.

Empfohlene Zitierweise für diesen Online-Artikel:

Kowalska, Iwona. "Voivods' Plans for a National Emergency System". Health Policy Monitor, October 2008. Available at http://www.hpm.org/survey/pl/a12/1